Insulin resistance and hyperinsulinemia in individuals with small, dense low density lipoprotein particles.

TLDR

Small, dense LDL particles (pattern B) are linked to dyslipidemia and insulin resistance, as reflected by altered triglyceride and HDL‑cholesterol levels. The study aimed to determine whether individuals with pattern B exhibit insulin resistance by measuring glucose and insulin responses to oral glucose, insulin‑mediated glucose disposal, and lipoprotein concentrations. Pattern B subjects displayed higher integrated plasma glucose and insulin responses, greater steady‑state plasma glucose during hyperinsulinemic‑euglycemic clamp, elevated triglycerides, lower HDL‑cholesterol, and higher blood pressure, confirming insulin resistance. J Clin Invest 1993;92:141‑146.

Abstract

Subjects characterized by a predominance of small LDL particles (pattern B) have changes in plasma triglyceride (TG) and HDL-cholesterol concentrations consistent with the presence of resistance to insulin-mediated glucose uptake.To pursue this issue, plasma glucose and insulin responses to oral glucose, insulin-mediated glucose disposal, and lipoprotein concentra- tions were measured in subjects categorized on the basis of LDL peak diameter measured by gradient gel electrophoresis.Subjects with pattern B had higher (P < 0.05-0.001 ) total integrated plasma glucose (20.7±1.0 mmol/liter * h) and insu- lin (1,743±293 pmol/ liter -h) responses to oral glucose com- pared with glucose (16.3±0.4 and 19.2±0.8 mmol/liter -h) and insulin (856±60 and 1,222±168 pmol/liter * h) responses in those with either pattern A or an intermediate pattern.Pat- tern B individuals were shown to be more insulin resistant on the basis of higher steady state plasma glucose concentrations (SSPG, 10.4±1.0,P < 0.002, vs. 7.5±0.7 and 6.0±0.4 mmol/ liter) after a constant infusion of somatostatin, glucose, and insulin than those with either the intermediate or pattern A subclass.Pattern B subjects also had higher concentrations of (P < 0.001) TG (1.98±0.15 vs. 133±0.17and 0.77±0.05mmol/liter) and lower (P < 0.01-0.001)HDL cholesterol (1.12±0.06 vs. 134±0.05vs. 1.45±0.05mmol/liter) than those with either the intermediate or pattern A. Finally, significant (P < 0.001 ) correlation coefficients existed between LDL diameter and SSPG (r = -0.44);glucose (r = -0.41)and insulin (r = -0.38)responses; TG (r = -0.65)and HDL-cho- lesterol (r = 0.42) concentrations; and systolic (r = -0.34)and diastolic (r = -0.34)blood pressure.Thus, pattern B subjects are insulin resistant, have higher glucose, insulin, and TG, lower HDL-cholesterol levels, and higher blood pressure than those with pattern A or intermediate.(J.Clin.Invest. 1993.92:141-146.)Key words: LDL particle diameter -glucose and insulin responses * resistance to insulin-mediated glucose up- take-lipid and lipoprotein concentrations * blood pressure pattern B LDL 1.